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San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, California95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sic-lov.org/phd Underground Storage Tank Program Inspection Report Facility Phone: I Date: Facility Name: CERS ID: Facility Address: Inspection Contact: Title: Phone: Inspection Type: Program: Consent For: Consent Given By: inspection Photos Sam les Ex Date: Service Technician Onsite: Exp.Date: Designated Operator: P• Service Technician Manufacturer's Training CM California o e or Kegu a ons = ea and Safetye TPR=Code of Federal Regulations V=Violation R=Repeat violation COS=Corrected on site during inspection File Review 101 HSC 25284 No permit to operate ❑V ❑ R ❑COS 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system ❑V ❑R ❑COS 103 HSC 25292.2 Current financial responsibility documents not submitted ❑V ❑R ❑COS 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current ❑V ❑R ❑COS F105HSC 25286(c) Current BOE number not submitted ❑V ❑R ❑COS CCR 2632 Monitoring and response plans not current or approved by the EHD ❑V ❑R c COS CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑V ❑R ❑COS 108 CCR 2637(f),2638(e) Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS 109 CCR 2637 Failed to test secondary containment ❑V ❑R ❑COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days ■V ❑R ❑COS 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually ❑V ❑R ❑COS 112 HSC 25284.2 Failed to test spill containers annually ❑V ❑ R ❑COS 113 CCR 2638(d) I Failed to submit monitoring system certification test report within 30 days ❑V ❑R ❑COS 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down ❑V ❑R ❑COS 115 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days ❑V ❑R ❑COS 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification ❑V ❑R ❑COS 117 HSC 25292.5 Failed to conduct ELD testing on a system located within 1000'of a public well ❑V ❑R ❑COS 118 HSC 25292.5 Failed to repair and retest system due to failed ELD test ❑V ❑R ❑COS 119 CCR 2644.1(a)(5) Failed to submit ELD test results within 60 days ❑V ❑R ❑COS repaired steel tank within 10 years of lining and every 5 years after ❑V ❑R u COS 120 CCR 2663 Failed to inspect a lined or 121 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests ❑V ❑R ❑COS 122 HSC 25299 Documents were falsified or misrepresented o ❑R ❑COS QCCR Permit to repair UST system not obtained ❑V ❑R COS Failed to submit UST Certification of Installation/Modification V ❑ R ❑COS Failed to submit a written response within 30 days of receiving an inspection report ❑V ❑R ❑COS Inspector: Phone: age 1 of 5